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TENSION PNEUMOTHORAX
Pediatric Respirology Division

Helmi Lubis
Ridwan M. Daulay
Wisman Dalimunthe
Rini S. Daulay
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Pneumothorax
• Abnormal collection of air in the
pleural space outside of the lung
• Air enter the pleural space by a leak
in either the visceral or parietal
pleura
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Classification of Pneumothorax:
▫ Spontaneous
▫ Primary
▫ Secondary
▫ Traumatic
 Iatrogenic
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Spontaneous Pneumothorax
• Primary occurs without trauma or
underlying lung disease
• Secondary complication of
underlying lung disorder:
▫ Pneumonia
▫ Pulmonary abscess
▫ Asthma
▫ Foreign body in the lung
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Traumatic Pneumothorax
• Result of blunt or penetrating trauma
to the chest wall
• Injury from a diagnostic or
therapeutic procedure  Iatrogenic
Pneumothorax
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Iatrogenic Pneumothorax
• Complicate of:
▫ Tracheostomy
▫ Thoracentesis
▫ Transbronchial byopsi
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Catamenial Pneumothorax
• Unusual condition
• Associated with menses
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Clinical Manifestations
• Sudden onset of chest pain
• Tachypnea
• Dyspnea
• Tachycardia
• Cyanosis
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Phisical Examination
• Involved lung:
▫ Decreased breath sounds
▫ Percussion: hyperresonance
• Larynx, trachea and heart  shifted
toward unaffected side
• Gurgling sounds synchronous with
respiration  open fistula connecting
with air containing tissues
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Diagnosis
• Radiographic examination:
▫ Chest X Ray AP and lateral:
 Air in the pleural space outlining the
visceral pleura/pleura line
 Hyperlucency
 Attenuation of vascular & lung marking on
the affected side
▫ CT of the chest:
 Detect bullae & blebs  recurrent
Pneumothorax
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Tension Pneumothorax ???

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• Inspiration  air enter the pleural

space
• Exhalation  air can not exit
• Lead to collapse of the affected lung &
shift of mediastinum away from the
affected side
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Evidence of tension:
• Shift of mediastinal structure away
from the side of air leak
• Basis of evidence of:
▫ Circulatory compromise
▫ Hearing a ”hiss” or rapid exit of the
air with the insertion of
thoracostomy tube
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Tension Pneumothorax causes:

• Limit expansion of contralateral lung
• May compromise venous return
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Definitive Treatment
• Closed thoracotomy:
▫ Drainage trapped air through a catheter
▫ External opening in a dependent
position under water  adequate to re-
expand the lung
• Open thoracotomy:
▫ Plication of blebs
▫ Closure of fistula
▫ Stripping of the pleura  apical lung
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• Chemical pleurodesis:
▫ Talc
▫ Tetracycline
▫ Silver Nitrate
• Pleural pain  analgetic treatment
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